@ ADHD medication questions

[lucybrown]

Feel free to answer for both yourself or your child.

Can anyone recommend a medication that has worked well with minimal insomnia?   Perhaps a non-stimulant?

I'm fatiguing of the trial and error of medication for both myself and my 9 yo.  She has been taking a low dose of Adderall XR with good results, but the sleep disturbances are just not worth it anymore.  We've also tried Vyvanse and Focalin.  Sleep is always an issue, even with all the good sleep hygiene etc. She's exhausted and we can't find a decent solution besides not taking her medication. I have also taken the same three medications with the same issues.  Lack of sleep ramps up my anxiety and depression symptoms.

Please don't offer sleep advice.  We've tried all the things.  I don't want to hear more ways to try to improve sleep. 

ETA: grammar

[wambam]

In college, I had a lot of issues, including sleep, with Adderall. I ended up on Dexedrine which contains one of the salts in Adderall but not the other. A lot of my side effects resolved from that. It’s still a stimulant though.

[lucybrown]

Feb 8, 2021 15:39:44 GMT -5 wambam said:

In college, I had a lot of issues, including sleep, with Adderall. I ended up on Dexedrine which contains one of the salts in Adderall but not the other. A lot of my side effects resolved from that. It’s still a stimulant though.

Thanks.  It's actually covered by our insurance, so maybe worth a shot.  I think it's shorter acting than Adderall XR.  
 

[tealblue]

Ds (8) has been sleeping horribly since starting adderal xr and his NP and therapist both said it’s unrelated. He takes it before 7 am everyday and also does melatonin sometimes. He also takes a magnesium supplement before bed. I don’t know if any of this is related or helpful for you but good to know others have sleep issues on adderall.

We have not done this but I did read about genetic testing to help narrow down the best drug for your particular makeup. Maybe worthwhile to ask if this is possible?

Sorry not helpful.

[IndiaInk]

DD(6.5) has been Adderall XR for the last 6 months but I haven't noticed it impacting her sleep much. She's always been a total insomniac, so that's just a constant challenge. The only way she falls alseep without a monumental struggle is with melatonin. I'd say her sleep challenges are the same and haven't gotten worse since starting Adderall.

[lucybrown]

Feb 8, 2021 15:53:58 GMT -5 tealblue said:

Ds (8) has been sleeping horribly since starting adderal xr and his NP and therapist both said it’s unrelated. He takes it before 7 am everyday and also does melatonin sometimes. He also takes a magnesium supplement before bed. I don’t know if any of this is related or helpful for you but good to know others have sleep issues on adderall.

We have not done this but I did read about genetic testing to help narrow down the best drug for your particular makeup. Maybe worthwhile to ask if this is possible?

Sorry not helpful.

It's definitely related to the Adderall XR.  She sleeps quite well when she doesn't take it.   ADHD still makes it hard for her to turn her brain off, but when she's out, she sleeps well.  My experience has been the same.  

We've been experimenting for a long time.  Taking it earlier helps, but doesn't eliminate the problem.  Melatonin gives me nightmares, so I'm reluctant to give it to my kid.  We supplement magnesium.  No screens, white noise, weighted blankets, limited sugar, no caffeine, bedtime meditations.  We've done it all.  Which is why I think it's time to try another medication change.

[AdaraMarie]

My dd takes nonstimulant guanfacine and it improved her sleep when she started taking it. Purely an anecdote though because I believe that it treats the primary adhd symptoms completely differently and may not be appropriate for you guys. She has never been on a stimulant. She also tried clonodine but it dropped her blood pressure so much at the initial dose that we were never able to get to a theraputic dose on that one. I don't think she got any benefit or sleep related side effects with that one but it's been a while.

[wambam]

Feb 8, 2021 15:51:21 GMT -5 lucybrown said:

Feb 8, 2021 15:39:44 GMT -5 wambam said:

In college, I had a lot of issues, including sleep, with Adderall. I ended up on Dexedrine which contains one of the salts in Adderall but not the other. A lot of my side effects resolved from that. It’s still a stimulant though.

Thanks.  It's actually covered by our insurance, so maybe worth a shot.  I think it's shorter acting than Adderall XR.  
 

It is. I tried the non-XR Adderall as well and still had irritably and sleep issues, FWIW.

[lucybrown]

Feb 8, 2021 16:22:50 GMT -5 AdaraMarie said:

My dd takes nonstimulant guanfacine and it improved her sleep when she started taking it. Purely an anecdote though because I believe that it treats the primary adhd symptoms completely differently and may not be appropriate for you guys. She has never been on a stimulant. She also tried clonodine but it dropped her blood pressure so much at the initial dose that we were never able to get to a theraputic dose on that one. I don't think she got any benefit or sleep related side effects with that one but it's been a while.

Thanks.  May I ask what her primary symptoms are?   

DD has inattentive type.  Her main issues relate to inattention and distractibility.  Her pedi suggested trying amphetamines or methylphenidates so we haven't tried anything else yet.  It seems like quite a few others on here also have kids that take guanfacine.  Perhaps it's indicated for particular symptoms or related conditions. 

Besides the sleep, I don't think the stimulants are doing either one of us any favors with anxiety.  I know we're living in a pandemic, but both of us have anxiety that is worse than ever.  It's tough to tease things apart. 

[CrazyLucky]

DS is 10 and takes methylphenidate, which is generic concerta. No sleeping issues.

[AdaraMarie]

lucybrown She has hyperactivity and impulsivity but also anxiety and sensory seeking bahaviors....so totally different.

[lucybrown]

AdaraMarie, thanks. Not totally different. DD also has anxiety and sensory behaviors. Her hyperactivity and impulsivity is mostly related to talking and interrupting. I appreciate the feedback.

[mae0111]

DD1 is 11 and has been on Vyvanse for about 18 months. She didn’t have sleep issues, but she does have anxiety. Her NP introduced guanfacine in addition to the vyvanse. It made her extremely tired. We experimented with time of day, and she simply could not function on it.

All that said, maybe guanfacine with Adderall would be a good combination - and not necessarily one or the other.

ETA DD1 has inattentive type, some sensory issues, anxiety, and NVLD tendencies that exacerbate her anxiety.

[longtimenopost]

My DD (8) couldn't do any of the long-acting/extended release stimulants. She takes short acting methylphenidate in a liquid form. She's meant to take it twice a day (once at school) but we discovered that she really only needs it in the morning before school, and she still does well for the couple of hours at school after it wears off. It doesn't interfere with her sleep at all.

[circa1978]

My 9YO is also on a low dose of Adderall XR. He's always been a terrible sleeper and this isn't helping but it's mostly been him staying up later. We give it as early as possible in the day - the minute he wakes up - and that's about the best advice I have.

ETA: We also don't give it on non-school days.

[nsl]

Feb 8, 2021 17:00:53 GMT -5 CrazyLucky said:

DS is 10 and takes methylphenidate, which is generic concerta. No sleeping issues.

Yes, this is what has worked best with my 10 year old.  I know it's not the best medication for a lot of kids, but he's experienced minimal side-effects since starting Concerta ~3 years ago. 

[raleighnc]

DDs are both on Jornay, which is methylphenidate they take at 8pm and it starts working around 10 hours later (so 5-6am) and is at therapeutic levels by the time they are getting ready in the morning. I can tell it's pretty much out of their system by 6. However, there's no generic and it can be spendy, but based on your trials, you could try getting a letter of necessity if your insurance doesn't cover it. They also have a fairly decent patient assistance coupon.

I don't know anyone personally that takes guanfacine, but it does usually make people very sleepy and they need to figure out the best time to take it. But since you've tried ritalin and adderall, it's something to think about. I also don't know anyone who has taken strattera, but that's another third-line option.

However, DD2 has always had disturbed sleep (hard time falling asleep, gets up and plays in the middle of the night, gets up super early). Like you, we've tried every hygiene and OTC option. Her pedi referred us to a pediatric neurologist/sleep specialist and we are going next week. Another friend had to take her toddler/prechooler because his sleep was so bad, and the neurologist prescribed meds. So there are options to help if you can't find a good solution with the ADHD med. Good luck!

ETA DD1 was on immediate release ritalin for a long time, and you can control the timing a bit better. However, there was just too much up and down in the med levels and she needed a smoother curve. But it can work fine for a lot of kids.

[expectantsteelerfan]

My ds takes Concerta (we have to do name brand, generic didn't work consistently for him) and guanfacine in the afternoon. Our experience with guanfacine is that it helps him chill out (might be good for anxiety), but I'd that's all he takes, it doesn't touch his hyperactivity or focus.

[Leeham Rimes]

Wes takes methylphenidate XR which, when I googled there are about 8 brand names it does under. I haven’t notice any sleep changes but he’s barely a week into it, he already sleeps like shit since he was a baby, and he takes melatonin.

My neighbor said if it got untenable to switch to a non XR version.

[gretchenindisguise]

I was going to ask about anxiety before I read further down and saw that she has anxiety.

Would it be possible to add in a medication for the anxiety?


(my kid has never slept and still doesn't sleep despite doing all of things. her brother does sleep though, so I've just decided it's her genetics and not our parenting)

[whattheheck]

I loved it when my son was on the Daytrana patch because I could pull it off right when he got home from school and have some sort of control over when it wore off. Also - he listened to sleep meditations and they were a game changer in our household.

[iheartbanjos]

We did guanfacine and Daytrana for non-stimulants and DD asked to go back to Vyvanse. We had to do genetic testing prior to going on a non-stimulant.

[BicycleBride]

I take Adderall xr and ds takes concerta. I have had trouble sleeping all of my life, regardless of medication. I started Ritalin at 9 for reference. I have moderate-severe inattentive type and from what I understand, chronic insomnia is a common problem among that subgroup. It actually takes concentration to fall asleep and historically I have slept better while taking stimulants than while not. So my first coarse of action would be to determine if the medication is actually causing the sleep problems. Usually stimulants get metabolized pretty quickly and people generally think they have more of an affect on night time sleep than they do.
DS (7) who has combined type, goes to sleep about 12 hours after he takes his meds in the morning and falls asleep quickly and sleeps deeply. He gets up pretty early and generally seems to be a morning person.

[akayf]

Feb 8, 2021 17:00:53 GMT -5 CrazyLucky said:

DS is 10 and takes methylphenidate, which is generic concerta. No sleeping issues.

My almost 13 year old DS has been on this for 3 years. He does take 5 mg melatonin on school nights. We didn’t realize he was having trouble sleeping until his developmental pedi asked. DH and I said no and kid was like well actually, I do have a hard time falling asleep. That’s why I’m tired in the morning. He doesn’t take melatonin on weekends since he can sleep late.

I will say the side effect we are dealing with is loss of appetite. He has only gained 5 lbs in tye past 3 years but has grown several inches.

[verycontrary247]

I switched from Adderall XR to a combo of Guanfacine and Wellbutrin XR when we started TTC. I take the Guanfacine at night and Wellbutrin in the morning and sleep great.

[chickatexxa]

Try Genesight genetic testing to help predict which meds will work best with the fewest side effects. 

[yentl]

The XR Adderall messed with my sleep so bad but I didn’t have the same issues with the immediate release version. Have you tried that instead?

[allaboutme]

Lame question.. did you get your children tested by their pediatrician or do they get referred to a specialist? Thinking my daughter should be evaluated but unsure where I should start. Would anyone be willing to elaborate on their child’s symptoms? Again, I apologize for interrupting with these questions.

[raleighnc]

I can't tell if both of you have anxiety, but DD1 does (along with ADHD), and her sleep did improve after starting Lexapro (about 18 months after starting ADHD meds). She falls asleep/shuts off her brain more easily and seems to sleep more restfully.

[raleighnc]

Feb 8, 2021 23:28:50 GMT -5 allaboutme said:

Lame question.. did you get your children tested by their pediatrician or do they get referred to a specialist? Thinking my daughter should be evaluated but unsure where I should start. Would anyone be willing to elaborate on their child’s symptoms? Again, I apologize for interrupting with these questions.

You can start with your pedi and move to a specialist if necessary. DD1 was diagnosed by an educational psychologist because we were testing for ADHD/anxiety/depression as well as learning disabilities. Once she was diagnosed with ADHD, it was very obvious that DD2 had similar symptoms, and we went to the pedi because we didn't suspect any comorbidities. The pedi managed medication for both of them until DD1 needed anti-anxiety meds too and transferred to a psychiatrist.